The Disability Determination Services (DDS) makes a medical determination regarding entitlement:

• •

  documents the determination on form SSA-833, and

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  returns the case to the FO via the Electronic Disability Collect System (EDCS) Action Items list.

EXR awards are high priority cases and should be expedited through all steps of the adjudication process, including the creation and effectuation of the EF-101.

NOTE: In dual entitlement situations, if the prior record terminated for substantial gainful activity (SGA) on both records, each entitlement needs a separate DDS medical decision and a separate SSA-833.

When DDS issues an EXR allowance, it will appear on the EDCS Action Items list. Follow these procedures:

1. 1. 

   Review the EXR approval on the SSA-833:

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     Item 9A will be selected;

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     Item 10 will show “other”;

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     Item 20 will show WRM code 31; and

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     Remarks will show “Expedited Reinstatement MOE MM/YY”.

2. 2. 

   Transfer the EXR event on the Disability Control File (DCF) from the DDS to the FO.

3. 3. 

   Complete the Electronic Form 101 (EF-101) following normal amended award procedures, see KC Net EXR EF101 guide. The following screens require entries unique to EXR awards:

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     EFACCT: Code the Critical Case indicator with “Y.” If Workers’ Compensation (WC) or Public Disability Benefits (PDB) is involved, code the WC/PDB Involved indicator with “Y.”

   • •

     EFPIAD: enter Primary Insurance Amounts (PIA) beginning with the EXR MOE. Although EXR re-establishes entitlement to payment, for PIA computation purposes, we proceed as though the original period of disability has not terminated. Therefore, use the disability onset date for the previously terminated period of entitlement, and compute the PIA as if the Extended Period of Eligibility (EPE) termination never occurred. Use all years of earnings not previously included in the Master Beneficiary Record (MBR) PIA history to compute the EXR PIA. For detailed information on the EPE PIA computations, refer to RS 00605.238.

   • •

     EFBENE: review all fields to ensure necessary screens are in the EF101 path (for example, garnishment or tax levy involvement).

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     EFBEN2: Code the “Disability Involved” indicator with “Y.” Even if work is involved, code the “Work Involved” indicator with “N.” Capture work information on the EFDIBWK screen. Bring the EFDIBWK screen into the EF101 path by coding the “SGA or EPE Involved” indicator on the EFBNDIB screen with “Y.” Code the “Appointed Representative Involved,” "Special Notice" due to Visual Impairment, and “SSI Windfall Offset” indicators as necessary.

   • •

     EFCOMM: select Common screens which affect entitlement (for example, beneficiary marriage or citizenship)

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     EFBNDIB: the DDO is the last day of the month prior to the EXR MOE (the date of entitlement to disability [DOED]). For example, if the DOED is 04/22, the DDO is 03/31/2022. Code the DAC field with “F.”

   • •

     The DOED cannot be earlier than the previous benefit termination month (BTM). The FO must use the MOE established by the DDS, shown on the SSA-833. The FO cannot change the MOE. If the FO cannot use the MOE established by the DDS (for example, because the claimant performed SGA in that month), send the case back to the DDS to determine a different MOE. If the PC discovers an incorrect MOE, designated PC technicians have authorization to correct certain DDS MOE determinations. If there is SGA-level work during the EXR Initial Reinstatement period (IRP) or the new EPE is involved, code the “SGA or EPE Involved” indicator with “Y.”

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     EFDIBWK: code SGA months in the EXR IRP and the new EPE, if applicable. Include this information in remarks on the EFBCRN screen.

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     EFBCLM: the application file date is the EXR protective filing date, if any. The application receipt date is the date we receive the completed EXR request.

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     EFBCRN: use remarks to alert the PC that this is an EXR case and requires priority handling. Use remarks to alert PSC to any special issues such as SGA months since the EXR MOE, payment of provisional benefits, WC/PDB, etc. If Medicare terminated prior to the EXR award date, add, “Award Medicare based on EXR – See HI 00801.166 – new IEP applicable” to remarks. However, if the claimant’s HI/SMI eligibility has not terminated, no additional remarks are necessary, as HI/SMI will continue based on EXR.

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     EFBNCM: this screen lists a selection of three separate menus. These screens provide access to Common Screens used for suspension, termination and reinstatement events for miscellaneous situations, disability events and foreign events.

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     EFMBEN: Compute the monthly amount payable as if the prior period never terminated due to SGA, increased by intervening COLAs and recomputations. Adjust benefits for any changes in offsets such as, Workers Compensation/Public Disability Benefits and Government Pension Offset, Windfall Elimination Provision, overpayments, and other payment issues with the first month of reinstated benefits.

4. 4. 

   Adjudicate and transfer the EF-101 to the program center (PC) per MS 06309.035 and MS 06309.036.

5. 5. 

   Use the Print function, #8 on the EFMENU screen, to send a copy of the EF-101 to ORS. Do not print a paper copy of the EF-101.

6. 6. 

   For EDCS exclusion cases store the SSA-833 in eView or the Evidence Portal (EP). If the forms listed in DI 13050.045B.2 are not in the electronic folder, fax them in.

7. 7. 

   Transfer the EXR event on the DCF to the PC per DI 13010.620.

8. 8. 

   The program center (PC) will issue the reinstatement notice.

If the beneficiary is not receiving provisional benefits, tickle the case for 20 days and check the MBR to verify that the PC has processed the reinstatement. If the beneficiary is receiving provisional benefits, tickle the case for 30 days and check the MBR to verify that the PSC has processed the reinstatement. If the reinstatement is not processed, follow these steps:

1. 1. 

   Query PCACS to verify location/jurisdiction of the EF-101 action.

2. 2. 

   Access the Detailed Office/Organization Resource System (DOORS) using the search SSN function and send an email to the appropriate PC component , with the subject line “EXR Award Effectuation Request.” Add a “special message” to the MBR indicating the date the effectuation request was sent.

3. 3. 

   Tickle the case for 10 days. If the MBR does not correctly reflect the reinstatement after the follow-up tickle expires and dire need or an adverse public relation situation exists, use the Manager-to-Manager process to contact the PCs per GN 01070.228. If the beneficiary is not receiving provisional benefits, technicians may issue critical payments if all statements are true:

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     The Disability Determination Services (DDS) has made a medical allowance on the claim, and

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     The EF101 is complete and transferred to the PC, and

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     The Master Beneficiary Record (MBR) has not been updated after the tickle expires and the claimant alleges dire need.

   For EDCS exclusion cases after the PC processes the EXR award, send the paper folder to the following address: National Records Center 6002 E GeoSpace Dr. 601 S 291 Hwy. Independence, MO 64056. Attach the correct coversheet for non-actionable Title II folders and mark the folder “All FO/PC Actions complete”.

Claimants have the right to representation while applying for EXR and any related appeals. We do not include provisional benefits in authorizing a fee under the fee agreement process. Do not use provisional benefits to calculate the amount of past due benefits to withhold for direct payment of a representative’s fee under the fee agreement or fee petition process, or to pay a fee authorized by a court. For more information on representative's fees, see GN 03913.000GN 03910.000, GN 03920.000, GN 03930.000 and GN 03940.000.